Medicare Hospice Benefits
Compassionate end-of-life care, fully covered by Medicare. Here's everything you need to know.
What Is the Medicare Hospice Benefit?
Medicare’s hospice benefit is a comprehensive program of care designed for individuals who are terminally ill and their families. Rather than pursuing curative treatment, hospice focuses on comfort, managing pain, controlling symptoms, and supporting quality of life during one of life’s most difficult transitions.
Covered under Medicare Part A (Hospital Insurance), the hospice benefit goes well beyond medical care. It is holistic by design, addressing physical, emotional, social, and spiritual needs, for both the patient and the family. A specially trained, interdisciplinary team works together around the clock to make sure you and your loved ones are never facing this journey alone.
Who Qualifies for Medicare Hospice Coverage?
To be eligible for Medicare’s hospice benefit, a patient must meet all of the following conditions:
Have Medicare Part A (Hospital Insurance)
Be certified as terminally ill - meaning both the hospice doctor and the patient's regular doctor (if they have one) must confirm a life expectancy of 6 months or less if the illness runs its normal course
Choose comfort care (palliative care) over curative treatment for the terminal illness and related conditions
Sign a Hospice Election Statement - a document that identifies the chosen hospice provider, confirms the start date of services, and acknowledges that the focus shifts from curative to comfort-based care
A few important points worth knowing:
- You do not need to have cancer to qualify – any terminal diagnosis may be eligible
- You do not need to sign a Do Not Resuscitate (DNR) order
- You do not need to be homebound
- You can stop hospice care at any time and return to regular Medicare coverage
- You can re-elect hospice care later if your condition warrants it
What Medicare covers
You can get a one-time only hospice consultation with a hospice medical director or hospice doctor to discuss your care options and management of your pain and symptoms. You can get this one-time consultation even if you decide not to get hospice care.
Once your hospice benefit starts, Original Medicare will cover everything you need related to your terminal illness, but the care you get must be from a Medicare-approved hospice provider.
Hospice care is usually given in your home, but it also may be covered in a hospice inpatient facility. Depending on your terminal illness and related conditions, the plan of care your hospice team creates can include any or all of these services:
Doctor and nursing care (skilled and supportive)
Physical, occupational, and speech-language therapy
Medical social services
Dietary and nutritional counseling
Prescription drugs for pain relief and symptom management
Hospice aide and homemaker services (no hourly restriction)
Medical and personal supplies such as bandages, catheters, and wound care materials
Medical equipment such as wheelchairs, walkers, and hospital beds
Volunteer services for patient and caregivers
Spiritual care and chaplain services
Grief, loss, and bereavement counseling for both the patient and the family
Short-term inpatient care for pain and symptom management that cannot be managed at home
Continuous home care during periods of medical crisis
24-hour on-call nurse and physician support
Before hospice begins, Medicare also covers a one-time consultation with a hospice medical director or doctor to discuss care options and pain management - even if the patient ultimately decides not to elect hospice.
How Long Does Medicare Hospice Coverage Last?
Hospice coverage does not have a hard expiration date. It is structured around benefit periods:
- Two 90-day benefit periods (initial phase)
- Followed by an unlimited number of 60-day benefit periods
At the start of the first 90-day period, both the hospice doctor and the patient’s regular doctor must certify terminal illness. For each period after that, the hospice medical director or physician must recertify that the patient remains terminally ill, after a face-to-face encounter with the patient beginning at the third benefit period.
If a patient lives longer than 6 months, they can continue receiving hospice care as long as recertification confirms ongoing eligibility. Patients also retain the right to change their hospice provider once per benefit period.
What Is NOT Covered Once Hospice Begins?
Choosing hospice means shifting the focus away from curing the terminal illness. As a result, once the hospice benefit starts, Medicare will not cover:
Treatment intended to cure your terminal illness and/or related conditions.
Prescription drugs unrelated to terminal illness symptom management (though these may be covered under Medicare Part D)
Care from any provider not arranged by the hospice team
Room and board (unless the hospice team arranges a covered inpatient stay)
Emergency room visits, hospital outpatient care, or ambulance transportation that is unrelated to the terminal illness and not arranged by the hospice team
Important: Always contact your hospice team before seeking outside services. If care is received outside the hospice arrangement without prior coordination, you may be responsible for the full cost. Patients have the right to request a written list from their hospice provider of any items, services, or drugs considered unrelated to the terminal illness, including the reasons for those determinations.
Cost Breakdown: What Will You Pay?
For most patients and families, the financial relief provided by the Medicare hospice benefit is significant. Here is what you can expect:
No deductible for hospice care
No charge for covered hospice services from a Medicare-approved provider
Up to $5 copayment per outpatient prescription for pain and symptom management
5% of the Medicare-approved amount for inpatient respite care (for example, if Medicare approves $100/day, you pay $5/day)
Monthly Medicare Part A and Part B premiums continue as usual
Room and board may apply if you reside in a nursing home or assisted living facility and receive hospice there (Medicare covers the hospice care itself, but not the room and board)
Deductible and coinsurance amounts apply for any Medicare-covered services treating conditions unrelated to your terminal illness
Patients with a Medigap (Medicare Supplement Insurance) policy will find that it covers hospice costs for drugs and respite care, as well as other health care expenses unrelated to the terminal illness.
The Four Levels of Medicare-Covered Hospice Care
Medicare recognizes four distinct levels of hospice care to meet patients wherever they are in their illness:
1. Routine Home Care
The most common level, provided in the patient's place of residence, which may be a private home, assisted living facility, memory care unit, or nursing home.
2. Continuous Home Care
Provided during brief periods of medical crisis, when sustained nursing care (at least 8 hours per day) is needed to manage acute symptoms and allow the patient to remain at home.
3. General Inpatient Care
Short-term care in a hospice inpatient facility, Medicare-participating hospital, or skilled nursing facility, used when pain or symptoms cannot be managed in any other setting.
4. Inpatient Respite Care
Short-term facility-based care (up to 5 consecutive days per occurrence) arranged by the hospice team to give family caregivers temporary relief.
Where Is Hospice Care Provided?
Hospice care is most commonly delivered in the place the patient calls home:
- Private residence
- Assisted living facility
- Memory care community
- Nursing home or skilled nursing facility
- Inpatient hospice facility (when medically necessary, arranged by the hospice team)
The goal is to keep patients surrounded by the people and environments that bring them comfort. When inpatient care becomes necessary, the hospice provider coordinates everything, from arranging the stay to handling payment directly with the facility.
Medicare Advantage (Part C) and Hospice
An important distinction: hospice care is covered under Medicare Part A, not Part C. This means that even if a patient is enrolled in a Medicare Advantage Plan, Original Medicare pays for hospice care, not the Advantage plan.
Patients in Medicare Advantage plans can stay enrolled in their plan during hospice. The Advantage plan continues to cover:
- Extra benefits such as dental and vision
- Services for health problems unrelated to the terminal illness
- Prescription drugs unrelated to the terminal illness (if the plan includes drug coverage)
If the Advantage plan doesn’t cover out-of-network services, Original Medicare will step in for any services unrelated to the terminal illness.
Before & Beyond: Consultations and Recertification
Before you decide - you're entitled to a free consultation.
Many families don't realize that Medicare covers a one-time consultation with a hospice medical director or physician before any decision is made. This meeting is designed to help patients and families understand all available care options, discuss pain and symptom management, and ask questions, with no obligation to elect hospice afterward. It is a valuable opportunity to make a fully informed decision, and it costs nothing out of pocket.
Staying on hospice - how recertification works.
Coverage doesn't renew automatically. After the first 90-day period, a hospice physician must recertify at the start of each benefit period that the patient remains terminally ill. Starting at the third benefit period, this recertification requires a mandatory face-to-face encounter between the patient and the hospice physician or nurse practitioner - without it, coverage cannot continue. Your hospice team is responsible for scheduling this visit, but knowing it's required helps families stay ahead of any delays.
We're Here When It Matters Most
Navigating Medicare coverage during such a significant time shouldn’t feel overwhelming. At Elevate Hospice, our team is here to walk alongside you, answering questions, coordinating care, and making sure your loved one receives everything they’re entitled to under their Medicare benefit.
Contact us today to learn more or to begin the enrollment process. We serve patients and families across Arizona with the compassion and expertise this moment deserves.
Frequently Asked Questions
Yes. If you choose your regular doctor, nurse practitioner, or physician assistant as your attending medical professional, you can continue seeing them as part of your hospice care team.
Absolutely. You have the right to revoke your hospice election at any time, return to standard Medicare coverage, and seek curative treatment. You may also re-elect hospice later.
ou have the right to an expedited review by a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). Your hospice provider is required to give you written notice at least two days before care ends, explaining your rights.
Yes. Original Medicare continues to pay for covered services treating health conditions that are unrelated to the terminal illness. You remain responsible for applicable deductibles and coinsurance for those services.
If your health stabilizes or improves, you may no longer meet hospice eligibility criteria. You can stop hospice care at any time, return to regular Medicare, and re-elect hospice later if needed.
For more information
You can get official Medicare publications and find helpful phone numbers and websites by visiting Medicare.gov or calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
To get help finding a hospice provider:
- Visit Medicare.gov.
- Talk to your doctor.
- Call your state hospice organization.
You can visit Medicare.gov/contacts, or call 1-800-MEDICARE to find the number for your state hospice organization.
To learn more about Medicare eligibility, coverage, and costs, visit Medicare.gov.
For free health insurance counseling and personalized help with insurance questions, call your State Health Insurance Assistance Program (SHIP). To find the contact information for your SHIP, visit shiptacenter.org or call 1-800-MEDICARE.